Challenges with Pediatric Mental Health

Aug 15, 2022 at 08:51 am by steve

Dan Marullo, PhD

Even in the best of times, surviving childhood and adolescence to become a healthy, functioning adult can be complicated. Just as you're trying to figure out who you are and think your way through a flood of hormones, you have to learn to cope with new problems, new feelings and adults' expectations with a brain that hasn't yet developed impulse control.

Children and adolescents coming of age today are facing an unusually difficult world. They have been through two years of isolation and loss from the pandemic. Daily news of war, climate disasters, and random shooters make it hard to feel safe. Meanwhile, the economic worries and stress of parents trickle down, and instead of role models, children are seeing endless videos of adults acting like badly behaved children, which makes it more difficult for children to learn appropriate social interaction.

"Before people become too discouraged, I remind them that there have always been hard times - the great depression, world wars and plagues far worse than our pandemic," Children's of Alabama pediatric psychologist Dan Marullo, PhD said, "Better times have always followed. We need to teach our children to be resilient and we should model the behaviors they will need to learn to help them cope with the ups and downs of life.

"It wouldn't be surprising if pediatricians are seeing more reports of headaches, stomach aches and eating disorders. Stress can have an effect on children's health, just as it does with adults. When children come in for an office visit, it's a good idea to see how they are doing psychologically.

"Clinically and in pediatric ERs, we're seeing an increase in anxiety and depression, especially in girls. There is also more suicidal ideation. Suicide is now the second leading cause of death in people under 24. Homicide is the third leading cause of death, and both are ahead of childhood cancer. "

As children of the great depression downsized to move into assisted living, many of their family members can attest to the lifetime effects a scarcity mentality had on their tendency to hang on to a basement full of things they intended to fix someday just in case they needed it. Are children of the pandemic likely to be dealing with similar lingering effects?

"The impact of living through lockdown will differ depending on the child and what each experienced. For those who are academically, socially or athletically oriented, switching to online classes probably felt like more of a loss. For students who were introverts or often bullied, it may have been a relief. Their stress came when it was time to return to the classroom."

The environment children lived in during lockdown will likely be the greatest influence on whether there is a lingering impact. Parents were also experiencing the emotional effects of stress, fear and eventually the short tempers that come from being in a confined space for too long. The situation was perfect for magnifying family dysfunctions and the potential for abuse.

With more than a million Americans dead from the virus, many children lost loved ones. In addition to the depression that comes with loss, an early awareness of death and the fact that bad things can happen may require an extra effort to help children feel safe, especially if they are fearful that something could happen to a parent or other loved one.

Fear is also entering the school room. After every school shooting, children are expressing their fears that a shooter might come to their school. Calming this anxiety will take a lot of listening and working with schools to take steps to help children feel safer.

"For so many kids, violence is nothing new," Marullo said. "Before they are out of elementary school, many inner city children know someone who was killed in the streets. Even those living in suburbs may see violence at home."

With each news story showing the face of a teen who went on a shooting rampage, we ask again how it could happen. Understanding the psychology of a killer is too complex for a quick generalization. Not every teen who is depressed or bullied becomes a killer, but it is often true that bullies were once bullied and those who are violent once experienced violence.

Disappointment and lack of hope are also common threads in teens who direct their anger outward in violence or inward in eating disorders, behaviors like cutting and suicide. It is also seen in young adults who seem to lose direction in life and come home to couch surf at age 40.

"Resilience is one of the most important gifts we can teach our children," Marullo said. "They need to learn that it's okay to try and fail. It's important for children to have an opportunity to practice overcoming adversity. This is one area where sports can help. Learning to work together as a team also helps children build empathy.

"Don't always try to rescue your children from failure or make everything perfect. Don't immediately fulfill every wish. Let them succeed through their own efforts.

"Children learn what they see adults. If you want to teach a child to be patient, model patience. If you want them to be truthful, kind and respectful, let them see you being truthful, kind and respectful. When you talk with them about difficult subjects such as the loss of a pet or grandparent, or troubling events in the news, be honest. Don't over-shelter them, and don't inundate them. Use words that are age appropriate and keep the content within the range that they can understand."

Another pediatric psychology topic in the news relates to gender. If children or young teens begin to show behaviors that suggest a gender identity other than their birth identity may be emerging, what is the appropriate response? How does a parent or healthcare provider distinguish between a momentary thought that is part of the "trying on" of identities some children go through or a fundamental aspect of personality that might benefit from counseling?

"A referral to a psychologist trained in gender issues can be helpful in determining whether follow-up is needed. If so, counseling can be beneficial to both the patient and family," Marullo said.

Although, childhood has never been as simple and idyllic as storybook images suggest, today's children do have challenges to overcome. With the help and example of caring family, community, healthcare providers and mental health professionals, children can grow up to become the well adjusted adults they were meant to be.

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